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Eur Ann Otorhinolaryngol Head Neck Dis. 2014 Apr;131(2):135-8. doi: 10.1016/j.anorl.2013.03.002. Epub 2013 Jul 9.

Acute severe neck pain and dysphagia following cervical maneuver: diagnostic approach.

Author information

  • 1Service d'ORL et chirurgie cervico-faciale, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, BP 90001, 57077 Metz cedex 3, France. Electronic address: domstrend@gmail.com.
  • 2Service d'ORL et chirurgie cervico-faciale, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, BP 90001, 57077 Metz cedex 3, France.
  • 3Service d'imagerie médicale, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, BP 90001, 57077 Metz cedex 3, France.

Abstract

INTRODUCTION:

Overlooking an etiologic hypothesis in acute neck pain with dysphagia may lead to misdiagnosis.

CASE REPORT:

A 51-year-old man who had received cervical manipulation came to the emergency unit with evolutive acute neck pain, cervical spine stiffness and odynophagia, without fever or other signs of identified pathology. Cervical X-ray and CT angiography of the supra-aortic vessels ruled out traumatic etiology (fracture or arterial dissection) and revealed an accessory bone, orienting diagnosis toward retropharyngeal abscess, which was, however, belied by endoscopy performed under general anesthesia. A second CT scan with contrast injection and tissue phase ruled out infection, revealing a retropharyngeal calcification inducing retropharyngeal edema. Evolution under analgesics was favorable within 13 days.

DISCUSSION:

Given a clinical triad associating acute neck pain, cervical spine stiffness and odynophagia, traumatic or infectious etiology was initially suspected. Cervical CT diagnosed calcific tendinitis of the longus colli, revealing a pathognomic retropharyngeal calcification. Secondary to hydroxyapatite deposits anterior to the odontoid process of the axis, this is a rare form of tendinopathy, usually showing favorable evolution in 10-15 days under analgesic and anti-inflammatory treatment.

Copyright © 2013 Elsevier Masson SAS. All rights reserved.

KEYWORDS:

Acute neck pain; Cervical maneuver; Retropharyngeal abscess; Retropharyngeal calcific tendinitis

PMID:
23845292
[PubMed - indexed for MEDLINE]
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